Posttraumatic Subsyndrome in CHIT (PTCHITS)

The post-traumatic subsyndrome represents
a spectrum of posttraumatic symptoms commonly referred
to within the context of DSM IV as acute stress disorder
and post- traumatic stress disorder. This constellation
of symptoms is considered functional in nature and
represents a psychological reactivity to the traumatic
event. It is assumed that when an individual experiences
trauma to the head during an event such as assault,
moving vehicle accident, slip & fall, or other
traumatic circumstances, there is the potential, inherent
in these situations, for the development of predictable
characteristic symptoms considered to be posttraumatic
in nature.

The primary basis for the development
of posttraumatic symptoms is a functional response
by the individual to the traumatic event. There may
be other physical findings associated with the event
that may occur as a consequence of the trauma, but
these are considered secondary with respect to etiology.
It is obviously of clinical importance for the clinician
to differentiate post-traumatic subsyndrome from postconcussive
subsyndrome. While many patients with postconcussive
symptoms also may develop posttraumatic symptoms,
clearly there are those patients, who experience trauma
to the head, which is not concussive in nature, and
present with minimal changes in intellectual and cognitive
functioning, but seem to develop posttraumatic symptomatology.

The most appropriate methodology for
differentiating this potential diagnostic overlap
is to have the patient complete neuropsychological
testing, in order to provide a more comprehensive
diagnostic assessment of cognitive functioning. Patients
with posttraumatic symptoms may have some cognitive
difficulties, but not of the same frequency or intensity
as patients who have experienced mild to moderate
brain injury. Neuropsychological testing is fairly
robust in being able to reveal primary cognitive impairment
versus cognitive problems that may be associated with
a posttraumatic disorder.